title: Postoperative emergence delirium in pediatric patients undergoing cataract surgery--a comparison of desflurane and sevoflurane.
abstract: BACKGROUND
  Desflurane and sevoflurane are associated with postoperative emergence delirium (ED) in children. The study aimed to compare the use of desflurane and sevoflurane to determine the postoperative ED in children undergoing cataract surgery using the validated Pediatric Anesthesia Emergence Delirium (PAED) scale.
  
  
  METHODS
  In this randomized double-blinded study, 88 children of American Society of Anesthesiologists (ASA) grade I and II aged 2-6 years, anesthesia was maintained with 1-1.2 MAC concentration of desflurane or sevoflurane after induction with sevoflurane. Subtenon block was administered in all children with 0.08-0.10 ml·kg(-1) of 0.5% bupivacaine before surgical incision. Primary outcome measured was PAED scale at different time intervals between the two groups, and secondary outcome measured was preoperative anxiety scores, postoperative pain scores, emergence, incidence of delirium and adverse effects.
  
  
  RESULTS
  Pediatric Anesthesia Emergence Delirium (PAED) scale showed no statistical difference between sevoflurane and desflurane at different time intervals. Incidence of ED using the cutoff of >12 in PAED scale was 8 of 44 (18.18%) in sevoflurane group and 9 of 44 (20.45%) in desflurane groups (P = 1.000). Emergence from anesthesia was faster in desflurane group (P = 0.001). Correlation between the m-YPAS anxiety scale and PAED scale in either group did not find any relationship (correlation coefficient = -0.060, P = 0.579). No correlation between the Face, Legs, Activity, Cry and Consolability (FLACC) scale and Pediatric Anesthesia Emergence Delirium (PAED) scale was found in 17 patients who had ED (correlation coefficient = 0.191, P-value = 0.462). Five patients of 17 (i.e., three patients in Group S and two patients in Group D) had PAED >12 but FLACC <4.
  
  
  CONCLUSIONS
  Emergence delirium (ED) after desflurane and sevoflurane anesthesia was comparable using a validated PAED scale in pediatric cataract surgery. There was no correlation between preoperative anxiety and ED in these children; however, children with higher pain scores were more likely to have a higher ED.
authors.affiliation: Department of Anesthesia, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Sameer
authors.initials: S
authors.lastname: Sethi
authors.forename: Babita
authors.initials: B
authors.lastname: Ghai
authors.forename: Jagat
authors.initials: J
authors.lastname: Ram
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Wig
mesh_terms: D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation / Q000009:adverse effects*; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D002387:Cataract Extraction / Q000523:psychology*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D003693:Delirium / Q000139:chemically induced / Q000453:epidemiology / Q000523:psychology*; D000077335:Desflurane; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology / Q000523:psychology*; D000077149:Sevoflurane; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane
keywords: cataract surgery; desflurane; emergence delirium; pediatric; sevoflurane; subtenon